Privacy Rights Request Form

We take your privacy seriously and do not sell or share personal information (PII) or protected health information (PHI). We use and disclose information only as permitted by applicable law, including the Health Insurance Portability and Accountability Act (HIPAA). Use this form to submit a request regarding your medical record or personal information, or to ask a privacy question.

HIPAA Rights Request—“I’m making a request related to my medical record.”
State Consumer Privacy Laws Rights Request—“I’m making a request related to my personal information not part of my medical record.”
See our HIPAA Notification for more information. Consumers can review how RadNet uses and discloses other identifiable information in our Privacy Statement.
If you would like to be removed from our promotional communications, contact us or click on the “unsubscribe” button located at the bottom of RadNet’s promotional email communications or reply “STOP” to any RadNet texts.
Type of Requester(check one):